Background@#Post-
transplant immunosuppression with
calcineurin inhibitors (CNIs) is associated with
kidney function impairment while
mammalian target of rapamycin (mTOR) inhibitors, such as
everolimus, can be used for its renal-sparing effects. In this study, we compared the
efficacy and
safety of
everolimus with low
dose tacrolimus (EVR+Low TAC) and conventional
dose tacrolimus (TAC) in
liver transplantation recipients. @*
Methods@#
Medical records of recipients
who received
liver transplantation at
Seoul National
University Bundang
Hospital from January 1st 2009 to December 31st 2018 were retrospectively reviewed. Cohort entry date was defined as the day
everolimus was initiated and
tacrolimus dosage was reduced. All
patients were followed up for 1 year.
Indicator of
efficacy was the
incidence of rejection and
safety was evaluated by
incidence of
drug adverse events including renal function. @*Results@#Among 118
patients, there were 40
patients (33.9%) in EVR+Low TAC group.
Incidence of rejection, including both
biopsy proven acute rejection and clinical rejection, was
similar in two groups [7.5% (n=3) vs. 6.4% (n=5), p=1.000]. Renal dysfunction was less frequent in EVR+Low TAC [17.5% (n=7) vs. 35.9% (n=28), p=0.038]. However,
incidence rates of
dyslipidemia,
oral ulcer were more frequent in EVR+Low TAC [45.0% (n=18) vs. 21.8% (n=17), p=0.009; 15.0% (n=6) vs. 1.3% (n=1), p=0.006]. @*Conclusions@#In terms of prevention of rejection, EVR+Low TAC was as effective as TAC and had renal-sparing effect but was associated with increased
risk of
dyslipidemia and
oral ulcer. This study demonstrates that EVR+Low TAC could be an alternative to
liver transplant recipients with nephrotoxicity after
administration of conventional
dose tacrolimus.